Muscle Tension in Generalized Anxiety Disorder During a Stressful Mental Arithmetic Task Direct Original Research

Main Article Content

Sungjin Im
Briana Rushing
Alexander Wright
Dzenita Softic
Arpana Lakhmani


generalized anxiety disorder, stress, electromyogrphy


Introduction: The purpose of this study was to compare muscle tension between individuals with and without generalized anxiety disorder (GAD) during a resting state and a stressful mental arithmetic task.

Methods: A total of 95 undergraduate students (68 females and 27 males; mean age=19.6, SD=3.5) completed an online survey on GAD symptoms and pathological worry, a diagnostic interview, and two laboratory tasks (resting and mental arithmetic tasks) while electromyography (EMG) signals were being recorded.

Results: We found a significant main effect of condition, F(1,93) = 24.13, p<.001, and group, F(1,93) = 4.55, p=.036. Furthermore, there was a significant interaction effect between condition and group, F(1,93) = 5.85, p=.017. A post-hoc analysis revealed that the increase in EMG activity from the resting period, 95% CI [.002398 .003474], to the mental arithmetic task, 95% CI [.003850 .005086], was significant for the GAD group, but not for the non-GAD group.

Conclusions: Individuals with and without GAD did not show significant differences in physiologically measured muscle tension at baseline. However, the GAD group showed higher levels of muscle tension during stressful situations when compared to the non-GAD group.

Abstract 315 | PDF Downloads 98


2. Malmo RB, Shagass C, Davis JF. Electromyographic studies of muscular tension in psychiatric patients under stress. J Clin Exp Psychopathol. 1951;12(1):45-66.
3. Sainsbury P, Gibson JG. Symptoms of anxiety and tension and the accompanying physiological changes in the muscular system. J Neurol Neurosurg Psychiatry. 1954;17(3):216-224. Doi: 10.1136/jnnp.17.3.216
4. Hoehn-Saric R, McLeod DR, Zimmerli WD. Somatic manifestations in women with generalized anxiety disorder. Psychophysiological responses to psychological stress. Arch Gen Psychiatry. 1989;46(12):1113-1119. Doi: 10.1001/archpsyc.1989.01810120055009
5. Hoehn-Saric R, Hazlett RL, McLeod DR. Generalized anxiety disorder with early and late onset of anxiety symptoms. Compr Psychiatry. 1993;34(5):291-298. Doi: 10.1016/0010-440x(93)90013-t
6. Wijsman J, Grundlehner, B., Penders, J., & Hermens, H. ACM Transactions on Embedded Computing Systems. 2013;12(4):1–20. Doi: 10.1145/2485984.2485987
7. Association AP. Anxiety Disorders. Diagnostic and statistical manual of mental disorders. 2022.
8. Pluess M, Conrad A, Wilhelm FH. Muscle tension in generalized anxiety disorder: a critical review of the literature. J Anxiety Disord. 2009;23(1):1-11. Doi: 10.1016/j.janxdis.2008.03.016
9. Behar E, DiMarco ID, Hekler EB, Mohlman J, Staples AM. Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications. J Anxiety Disord. 2009;23(8):1011-1023. Doi: 10.1016/j.janxdis.2009.07.006
10. McLaughlin KA, Borkovec TD, Sibrava NJ. The effects of worry and rumination on affect states and cognitive activity. Behav Ther. 2007;38(1):23-38. Doi: 10.1016/j.beth.2006.03.003
11. McNulty WH, Gevirtz RN, Hubbard DR, Berkoff GM. Needle electromyographic evaluation of trigger point response to a psychological stressor. Psychophysiology. 1994;31(3):313-316. Doi: 10.1111/j.1469-8986.1994.tb02220.x
12. Hazlett RL, McLeod DR, Hoehn-Saric R. Muscle tension in generalized anxiety disorder: elevated muscle tonus or agitated movement? Psychophysiology. 1994;31(2):189-195. Doi: 10.1111/j.1469-8986.1994.tb01039.x
13. Raskin M, Bali LR, Peeke HV. Muscle biofeedback and transcendental meditation. A controlled evaluation of efficacy in the treatment of chronic anxiety. Arch Gen Psychiatry. 1980;37(1):93-97. Doi: 10.1001/archpsyc.1980.01780140095011
14. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097. Doi: 10.1001/archinte.166.10.1092
15. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57. URL:
16. Willmann M, Bolmont B. The trapezius muscle uniquely lacks adaptive process in response to a repeated moderate cognitive stressor. Neurosci Lett. 2012;506(1):166-169. Doi: 10.1016/j.neulet.2011.10.073
17. Fridlund AJ, Cacioppo JT. Guidelines for human electromyographic research. Psychophysiology. 1986;23(5):567-589. Doi: 10.1111/j.1469-8986.1986.tb00676.x
18. Hoehn-Saric R, McLeod DR, Zimmerli WD. Symptoms and treatment responses of generalized anxiety disorder patients with high versus low levels of cardiovascular complaints. Am J Psychiatry. 1989;146(7):854-859. Doi: 10.1001/archpsyc.1989.01810120055009
19. Hoehn-Saric R, Hazlett RL, Pourmotabbed T, McLeod DR. Does muscle tension reflect arousal? Relationship between electromyographic and electroencephalographic recordings. Psychiatry Res. 1997;71(1):49-55. Doi: 10.1016/s0165-1781(97)00037-1
20. American Psychiatric Association & Spitzer RL. Diagnostic and Statistical Manual of Mental Disorders III. American psychiatric association. 1980.
21. Barlow DH, Cohen, A. S., Waddell, M. T., Vermilyea, B. B., Klosko, J. S.,, Blanchard EB, et al. Panic and generalized anxiety disorders:nature and treatment. Behavior Therapy. 1984;15(5):431–449. Doi: 10.1016/S0005-7894(84)80048-9